A Case of Useful Thoracoscopy Under Local Anesthesia for the Close Examination of Bilious Pleural Effusion

DOI
  • Kobayashi Genya
    Department of Respiratory Medicine, Nagoya City University East Medical Center
  • Toda Sanae
    Department of Respiratory Medicine, Kojunkai Daido Hospital
  • Mukai Aya
    Department of Respiratory Medicine, Nagoya City University East Medical Center
  • Arakawa Sosuke
    Department of Respiratory Medicine, Nagoya City University East Medical Center
  • Kitamura Yuki
    Department of Respiratory Medicine, Nagoya City University East Medical Center
  • Nakano Akiko
    Department of Respiratory Medicine, Nagoya City University East Medical Center
  • Kawaguchi Yuko
    Department of Respiratory Medicine, Nagoya City University East Medical Center
  • Maeda Hiroyoshi
    Department of Respiratory Medicine, Nagoya City University East Medical Center

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Other Title
  • 胆汁性胸水の精査に局所麻酔下胸腔鏡検査が有用であった1例

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<p>Background. Bilious pleural effusion is a rare condition in which intra-abdominal bile transitions into the thoracic cavity, causing the pleural fluid to turn brown. It is considered to be caused by abdominal disease. Case presentation. A 79-year-old woman presented to the hospital for the examination of dyspnea on exertion and right pleural effusion. Brown to black pleural effusion was found on thoracic drainage, and a diagnosis of bilious pleural effusion was made based on elevated pleural bilirubin and glycocholic acid levels. Thoracoscopy under local anesthesia was performed, and nodular lesions were found on the diaphragmatic pleura. A biopsy of the same area revealed a diagnosis of adenocarcinoma of the lung. Contrast-enhanced computed tomography of the thorax and abdomen showed no obvious abnormalities in the hepatobiliary or pancreatic regions. This case was considered to involve pleural seeding at the diaphragm, with invasion of the liver causing bile to transition into the thoracic cavity. Conclusion. In cases of bilious pleural effusion caused by thoracic disease, thoracoscopy under local anesthesia is useful for a closer examination.</p>

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